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Objective To examine patient willingness and a possible shift in willingness for surgery and to investigate factors associated with this shift, following participation in the digital nonsurgical osteoarthritis (OA) treatment program Joint Academy. Methods A total of 458 individuals (mean ± SD age 62 ± 5.6 years, 67% women) with diagnosed hip or knee OA were evaluated after 6 weeks in the Joint Academy program, comprising education and exercise as well as asynchronous chat with a physical therapist. Data describing joint pain, health‐related quality of life (the EuroQol 5‐domain [EQ‐5D] questionnaire in 3 levels), walking difficulties, the 30‐second chair stand test, and willingness to consider surgery were collected at baseline and at 6 weeks. Results At follow‐up, 31% of those participants willing to consider surgery at baseline no longer considered surgery. Of those participants who were unwilling to consider surgery at baseline, 6% reconsidered and decided in favor of surgery at follow‐up. Less pain and a higher EQ‐5D score at 6 weeks were associated with the change from being willing to unwilling to consider surgery at follow‐up (odds ratio [OR] 0.67–1.64; P < 0.05). Worse pain, a lower EQ‐5D score, and having walking difficulties at 6 weeks, and a lower pain and EQ‐5D score improvement were associated with the change from being unwilling to willing to consider surgery at 6 weeks (OR 0.51–4.30; P < 0.005). Conclusion Evidence‐based nonsurgical OA treatment, at least delivered in a digital format, may reduce the need for surgery and should therefore be offered as the first‐line treatment option to patients with hip and knee OA. The results also support the idea that such treatment programs have the potential to improve selection of patients for total joint replacement.

The associations identified in this review indicate that investigation of strengthening of the trunk muscles, and improvement of gluteus maximus activation and ankle ROM to change knee kinematics is merited. Studies on modifiable factors associated with increased knee abduction angle in people with knee injury are needed.

Article type : Original Article Willingness to undergo joint surgery following a first-line intervention for osteoarthritis: data from the BOA register.